|
TREAT FRACTURE RADIUS/ULNA
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
76100630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.56 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$352.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.56
|
| Rate for Payer: Anthem Medicaid |
$194.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$437.13
|
| Rate for Payer: Healthspan PPO |
$350.99
|
| Rate for Payer: Humana Medicaid |
$194.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$313.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.44
|
| Rate for Payer: Molina Healthcare Passport |
$194.55
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$180.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.50
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
76100631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$292.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
76100631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$126.75 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$750.75
|
| Rate for Payer: Anthem Medicaid |
$335.30
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$760.50
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$809.25
|
| Rate for Payer: First Health Commercial |
$926.25
|
| Rate for Payer: Humana Commercial |
$828.75
|
| Rate for Payer: Humana KY Medicaid |
$335.30
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$338.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$799.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$719.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$342.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$858.00
|
| Rate for Payer: Ohio Health Group HMO |
$731.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$195.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$126.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$302.25
|
| Rate for Payer: PHCS Commercial |
$936.00
|
| Rate for Payer: United Healthcare All Payer |
$858.00
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
76100630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$203.93 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem Medicaid |
$619.02
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$203.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$285.50
|
| Rate for Payer: CareSource Just4Me Medicare |
$275.31
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Humana KY Medicaid |
$619.02
|
| Rate for Payer: Humana Medicare Advantage |
$203.93
|
| Rate for Payer: Kentucky WC Medicaid |
$625.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$244.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$1,800.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
76100630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,728.00 |
| Rate for Payer: Aetna Commercial |
$1,386.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,404.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$1,494.00
|
| Rate for Payer: First Health Commercial |
$1,710.00
|
| Rate for Payer: Humana Commercial |
$1,530.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,476.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,584.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,350.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.00
|
| Rate for Payer: PHCS Commercial |
$1,728.00
|
| Rate for Payer: United Healthcare All Payer |
$1,584.00
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$2,185.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
45000131
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$284.05 |
| Max. Negotiated Rate |
$2,097.60 |
| Rate for Payer: Aetna Commercial |
$1,682.45
|
| Rate for Payer: Anthem Medicaid |
$751.42
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.30
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cash Price |
$1,092.50
|
| Rate for Payer: Cigna Commercial |
$1,813.55
|
| Rate for Payer: First Health Commercial |
$2,075.75
|
| Rate for Payer: Humana Commercial |
$1,857.25
|
| Rate for Payer: Humana KY Medicaid |
$751.42
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$759.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$437.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$677.35
|
| Rate for Payer: PHCS Commercial |
$2,097.60
|
| Rate for Payer: United Healthcare All Payer |
$1,922.80
|
|
|
TREAT FRACTURE RADIUS/ULNA(P
|
Professional
|
Both
|
$975.00
|
|
|
Service Code
|
HCPCS 25605
|
| Hospital Charge Code |
761P0631
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$275.93 |
| Max. Negotiated Rate |
$975.00 |
| Rate for Payer: Aetna Commercial |
$809.34
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$275.93
|
| Rate for Payer: Anthem Medicaid |
$385.15
|
| Rate for Payer: Buckeye Medicare Advantage |
$975.00
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cash Price |
$487.50
|
| Rate for Payer: Cigna Commercial |
$872.32
|
| Rate for Payer: Healthspan PPO |
$770.91
|
| Rate for Payer: Humana Medicaid |
$385.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$711.55
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$392.85
|
| Rate for Payer: Molina Healthcare Passport |
$385.15
|
| Rate for Payer: Multiplan PHCS |
$585.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$682.50
|
| Rate for Payer: UHCCP Medicaid |
$289.73
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$389.00
|
|
|
TREAT FRACTURE RADIUS/ULNA(P
|
Professional
|
Both
|
$1,800.00
|
|
|
Service Code
|
HCPCS 25600
|
| Hospital Charge Code |
761P0630
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.56 |
| Max. Negotiated Rate |
$1,800.00 |
| Rate for Payer: Aetna Commercial |
$352.71
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$171.56
|
| Rate for Payer: Anthem Medicaid |
$194.55
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,800.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cash Price |
$900.00
|
| Rate for Payer: Cigna Commercial |
$437.13
|
| Rate for Payer: Healthspan PPO |
$350.99
|
| Rate for Payer: Humana Medicaid |
$194.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$313.67
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$198.44
|
| Rate for Payer: Molina Healthcare Passport |
$194.55
|
| Rate for Payer: Multiplan PHCS |
$1,080.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,260.00
|
| Rate for Payer: UHCCP Medicaid |
$180.14
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$196.50
|
|
|
TREAT FRACTURE ULNAR STYLOID
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
76100642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.07 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$891.22
|
| Rate for Payer: Anthem Medicaid |
$421.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$977.21
|
| Rate for Payer: Healthspan PPO |
$807.26
|
| Rate for Payer: Humana Medicaid |
$421.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$762.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$429.49
|
| Rate for Payer: Molina Healthcare Passport |
$421.07
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.28
|
|
|
TREAT FRACTURE ULNAR STYLOID
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
76100642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$8,661.10 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem Medicaid |
$481.46
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$6,186.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$8,661.10
|
| Rate for Payer: CareSource Just4Me Medicare |
$8,351.78
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Humana KY Medicaid |
$481.46
|
| Rate for Payer: Humana Medicare Advantage |
$6,186.50
|
| Rate for Payer: Kentucky WC Medicaid |
$486.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,423.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$491.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
TREAT FRACTURE ULNAR STYLOID
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
76100642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$1,344.00 |
| Rate for Payer: Aetna Commercial |
$1,078.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,092.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$1,162.00
|
| Rate for Payer: First Health Commercial |
$1,330.00
|
| Rate for Payer: Humana Commercial |
$1,190.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,148.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,033.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$420.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,232.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,050.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$280.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$182.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$434.00
|
| Rate for Payer: PHCS Commercial |
$1,344.00
|
| Rate for Payer: United Healthcare All Payer |
$1,232.00
|
|
|
TREAT FRACTURE ULNAR STYLOI(P
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
HCPCS 25652
|
| Hospital Charge Code |
761P0642
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$421.07 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$891.22
|
| Rate for Payer: Anthem Medicaid |
$421.07
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,400.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cigna Commercial |
$977.21
|
| Rate for Payer: Healthspan PPO |
$807.26
|
| Rate for Payer: Humana Medicaid |
$421.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$762.70
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$429.49
|
| Rate for Payer: Molina Healthcare Passport |
$421.07
|
| Rate for Payer: Multiplan PHCS |
$840.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$980.00
|
| Rate for Payer: UHCCP Medicaid |
$490.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$425.28
|
|
|
TREAT HAND BONE LESION
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
76100656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.74 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$760.18
|
| Rate for Payer: Anthem Medicaid |
$294.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$838.45
|
| Rate for Payer: Healthspan PPO |
$688.56
|
| Rate for Payer: Humana Medicaid |
$294.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$300.63
|
| Rate for Payer: Molina Healthcare Passport |
$294.74
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.69
|
|
|
TREAT HAND BONE LESION
|
Facility
|
IP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
76100656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$390.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
TREAT HAND BONE LESION
|
Facility
|
OP
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
76100656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.00 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$1,001.00
|
| Rate for Payer: Anthem Medicaid |
$447.07
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,014.00
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$1,079.00
|
| Rate for Payer: First Health Commercial |
$1,235.00
|
| Rate for Payer: Humana Commercial |
$1,105.00
|
| Rate for Payer: Humana KY Medicaid |
$447.07
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$451.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,066.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$959.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$456.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,144.00
|
| Rate for Payer: Ohio Health Group HMO |
$975.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$260.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$169.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$403.00
|
| Rate for Payer: PHCS Commercial |
$1,248.00
|
| Rate for Payer: United Healthcare All Payer |
$1,144.00
|
|
|
TREAT HAND BONE LESION(P
|
Professional
|
Both
|
$1,300.00
|
|
|
Service Code
|
HCPCS 26034
|
| Hospital Charge Code |
761P0656
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$294.74 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$760.18
|
| Rate for Payer: Anthem Medicaid |
$294.74
|
| Rate for Payer: Buckeye Medicare Advantage |
$1,300.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cash Price |
$650.00
|
| Rate for Payer: Cigna Commercial |
$838.45
|
| Rate for Payer: Healthspan PPO |
$688.56
|
| Rate for Payer: Humana Medicaid |
$294.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$654.82
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$300.63
|
| Rate for Payer: Molina Healthcare Passport |
$294.74
|
| Rate for Payer: Multiplan PHCS |
$780.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$910.00
|
| Rate for Payer: UHCCP Medicaid |
$455.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$297.69
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
IP
|
$865.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
76100730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$830.40 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$259.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
TREAT HAND DISLOCATION
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 26685
|
| Hospital Charge Code |
36001268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$867.79 |
| Rate for Payer: Aetna Commercial |
$804.57
|
| Rate for Payer: Anthem Medicaid |
$368.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$867.79
|
| Rate for Payer: Healthspan PPO |
$728.77
|
| Rate for Payer: Humana Medicaid |
$368.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.88
|
| Rate for Payer: Molina Healthcare Passport |
$368.51
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.20
|
|
|
TREAT HAND DISLOCATION
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
76100730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.58 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$563.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$219.58
|
| Rate for Payer: Anthem Medicaid |
$261.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.00
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$606.58
|
| Rate for Payer: Healthspan PPO |
$548.01
|
| Rate for Payer: Humana Medicaid |
$261.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$266.50
|
| Rate for Payer: Molina Healthcare Passport |
$261.27
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$605.50
|
| Rate for Payer: UHCCP Medicaid |
$230.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.88
|
|
|
TREAT HAND DISLOCATION
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
HCPCS 26685
|
| Hospital Charge Code |
360P1268
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$271.25 |
| Max. Negotiated Rate |
$867.79 |
| Rate for Payer: Aetna Commercial |
$804.57
|
| Rate for Payer: Anthem Medicaid |
$368.51
|
| Rate for Payer: Buckeye Medicare Advantage |
$775.00
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cash Price |
$387.50
|
| Rate for Payer: Cigna Commercial |
$867.79
|
| Rate for Payer: Healthspan PPO |
$728.77
|
| Rate for Payer: Humana Medicaid |
$368.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$701.07
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$375.88
|
| Rate for Payer: Molina Healthcare Passport |
$368.51
|
| Rate for Payer: Multiplan PHCS |
$465.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$542.50
|
| Rate for Payer: UHCCP Medicaid |
$271.25
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$372.20
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
OP
|
$865.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
76100730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$112.45 |
| Max. Negotiated Rate |
$1,945.78 |
| Rate for Payer: Aetna Commercial |
$666.05
|
| Rate for Payer: Anthem Medicaid |
$297.47
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$1,389.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$674.70
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$1,945.78
|
| Rate for Payer: CareSource Just4Me Medicare |
$1,876.28
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$717.95
|
| Rate for Payer: First Health Commercial |
$821.75
|
| Rate for Payer: Humana Commercial |
$735.25
|
| Rate for Payer: Humana KY Medicaid |
$297.47
|
| Rate for Payer: Humana Medicare Advantage |
$1,389.84
|
| Rate for Payer: Kentucky WC Medicaid |
$300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$709.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$638.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$303.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$761.20
|
| Rate for Payer: Ohio Health Group HMO |
$648.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$173.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$112.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$268.15
|
| Rate for Payer: PHCS Commercial |
$830.40
|
| Rate for Payer: United Healthcare All Payer |
$761.20
|
|
|
TREAT HAND DISLOCATION(P
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 26675
|
| Hospital Charge Code |
761P0730
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$219.58 |
| Max. Negotiated Rate |
$865.00 |
| Rate for Payer: Aetna Commercial |
$563.28
|
| Rate for Payer: Anthem HMO/Medicare Advantage/POS/PPO/Pathway Tiered Hospital/Pathway X Tiered Hospital/Traditional |
$219.58
|
| Rate for Payer: Anthem Medicaid |
$261.27
|
| Rate for Payer: Buckeye Medicare Advantage |
$865.00
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cash Price |
$432.50
|
| Rate for Payer: Cigna Commercial |
$606.58
|
| Rate for Payer: Healthspan PPO |
$548.01
|
| Rate for Payer: Humana Medicaid |
$261.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$496.36
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$266.50
|
| Rate for Payer: Molina Healthcare Passport |
$261.27
|
| Rate for Payer: Multiplan PHCS |
$519.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$605.50
|
| Rate for Payer: UHCCP Medicaid |
$230.56
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$263.88
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
76100800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$2,457.60 |
| Rate for Payer: Aetna Commercial |
$1,971.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,996.80
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$2,124.80
|
| Rate for Payer: First Health Commercial |
$2,432.00
|
| Rate for Payer: Humana Commercial |
$2,176.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,099.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,889.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$768.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,252.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$332.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.60
|
| Rate for Payer: PHCS Commercial |
$2,457.60
|
| Rate for Payer: United Healthcare All Payer |
$2,252.80
|
|
|
TREAT HIP DISLOCATION
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
76100800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$755.25 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna Commercial |
$1,409.23
|
| Rate for Payer: Anthem Medicaid |
$755.25
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,560.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$1,538.96
|
| Rate for Payer: Healthspan PPO |
$1,276.46
|
| Rate for Payer: Humana Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$1,177.10
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$770.36
|
| Rate for Payer: Molina Healthcare Passport |
$755.25
|
| Rate for Payer: Multiplan PHCS |
$1,536.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,792.00
|
| Rate for Payer: UHCCP Medicaid |
$896.00
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$762.80
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$2,560.00
|
|
|
Service Code
|
HCPCS 27253
|
| Hospital Charge Code |
76100800
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$332.80 |
| Max. Negotiated Rate |
$2,457.60 |
| Rate for Payer: Aetna Commercial |
$1,971.20
|
| Rate for Payer: Anthem Medicaid |
$880.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,996.80
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cigna Commercial |
$2,124.80
|
| Rate for Payer: First Health Commercial |
$2,432.00
|
| Rate for Payer: Humana Commercial |
$2,176.00
|
| Rate for Payer: Humana KY Medicaid |
$880.38
|
| Rate for Payer: Kentucky WC Medicaid |
$889.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,099.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,889.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$768.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$898.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,252.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,920.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$512.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$332.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.60
|
| Rate for Payer: PHCS Commercial |
$2,457.60
|
| Rate for Payer: United Healthcare All Payer |
$2,252.80
|
|
